New Discoveries May Help Treat Blood Disease That Plagues African-Americans

Scientists may be close to finding a cure for sickle cell anemia, a blood disease that disproportionately affects African-Americans.

One in 500 African descendants born in the United States suffer from sickle cell; one in 12 carry the gene for it. The disease can cause symptoms as minor as fatigue, or as major as organ damage. A person suffering from sickle cell has defective hemoglobin that leads to abnormally shaped red blood cells, which get caught in the veins and cause circulation issues.

But a long-term experiment run out of the University of Michigan Medical School found that doctors might be able to treat these symptoms by using an antidepressant:

Their study, which includes more than 30 years of research, found that the antidepressant tranylcypromine, or TCP, may essentially reverse the effects of the disorder.[...]

But while U-M scientists say it’s too early to test out TCP as a treatment for sickle cell disease, they’re confident their findings hold promise.[...]

The first clinical trial on TCP and its affect on sickle cell is now being planned with researchers at Wayne State University in Detroit. Further information will be available later this year if it receives approval to go forward.

African-Americans disproportionately struggle to access the health care they need. Socioeconomic and environmental reasons — and the root cause, racism — are, of course, the reason for the disparity. Ultimately, the lack of care for back communities might funnel down to the research level. It’s suspected that less funding is awarded for research toward diseases that affect black people at a higher rate than white.

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Threshold Pharma shares rise on analyst upgrade

NEW YORK -- Shares of Threshold Pharmaceuticals Inc. rose Wednesday after a Piper Jaffray analyst upgraded the stock as the company prepares to report more clinical trial data for its experimental cancer drug TH-302.

THE SPARK: Analyst Charles Duncan raised his rating to "Overweight" from "Neutral" and doubled his price target to $10 per share from $5. Threshold is getting ready to report clinical trial data for TH-302 as a treatment for soft tissue sarcoma, but Duncan said investors are overlooking earlier-stage clinical trials of the drug as a treatment for leukemia, multiple myeloma, and gastrointestinal tumors and kidney cancer.

THE BIG PICTURE: TH-302 is designed to become active in parts of the body with abnormally low oxygen levels. Threshold said those conditions exist in many types of solid tumors because of the irregular growth of the blood vessels that feed the tumors. Once the drug becomes active, it stops cancer cells from replicating their DNA and dividing. The company said the drug can also attack oxygenated regions of the tumor.

"We believe that near-term data will enhance conviction on the broad applicability of Threshold's hypoxia-activation platform for targeting a wide range of cancer indications with the potential to substantively add/extend efficacy over standard chemotherapy," said Duncan.

Duncan said he is particularly interested in the possibility that TH-302 could be combined with drugs that block the blood vessel growth in tumors.

The South San Francisco, Calif., company is conducting late-stage trials of TH-302 as a treatment for soft tissue sarcoma and pancreatic cancer and early-stage trials in other cancers. It is developing TH-302 through a partnership with German drugmaker Merck KGaA.

SHARE ACTION: Threshold shares rose 45 cents, or 10 percent, to $4.91 in afternoon trading. The stock has traded between $3.30 and $9.28 in the last year, but has lost about half its value since Sept. 17 when it reported disappointing trial results for TH-302 as a treatment for pancreatic cancer.

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Carter: Obama thanked grandson for '47 percent' video

President Obama thanked Jimmy Carter's grandson for his work in making public the secretly recorded "47 percent" Mitt Romney video, the former president said in a CNN interview airing Thursday.

"When James went to meet President Obama, President Obama ran across the room, embraced him and thanked him profusely for his time, by the way," Carter said.

The video, which shows Romney describing nearly half of Americans as "dependent" on government, created a national controversy and was thought to deal a serious blow to the Republican nominee's presidential chances.

"There are 47% of people who are with him [Obama], who are dependent on government, who believe that they are victims, who believe the government has to care for them, who believe that they are entitled to health care, to food, to housing, you-name-it," Romney said at a private Florida fundraiser last year.

James Carter, the president's grandson, reportedly encouraged the owner of the video to turn it over to Mother Jones magazine.

In the interview airing Thursday, President Carter said the release of the tape was a "pivotal moment" in the contest.

"It was something [Romney] could not deny and it stuck with him for the rest of the election and I think it was a major factor, if not the major factor," he said, adding he believed it won Obama the election.

Obama met with Carter's grandson while in Atlanta for a post-State of the Union rally to champion his universal pre-K initiative.

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Here Comes The Boom: CMS Slashes Medicare Advantage; 'Disarray For Many Seniors'

WASHINGTON - DECEMBER 23: U.S. President Barack Obama signs the payroll tax bill in the Oval Office December 23, 2011 in Washington, DC. Payroll taxes fund Social Security and Medicare. (Image credit: Getty Images via @daylife)

Though Democrats denied it during the 2012 campaign, Obamacare cut Medicare by $716 billion in order to partially fund $1.9 trillion in new entitlement spending over the next ten years. A big chunk of those Medicare cuts came from the market-oriented Medicare Advantage program. Cleverly, the Obama administration postponed the Medicare Advantage cuts until after the election, so as to persuade seniors that everything would be just fine. But the election is over. On Friday, the administration announced that it would be significantly reducing funding for the popular program. Obama’s proposal, according to one analyst, “would turn almost every plan in the industry unprofitable.”

Democrats have long been hostile to the Medicare Advantage program, which allows seniors to get their Medicare coverage through plans administered by private insurers. Today, more than a quarter of retirees get their coverage through Medicare Advantage, and the program has experienced rapid growth over the past decade. Richard Foster, the recently-retired chief actuary of the Medicare program, has projected that Obamacare’s cuts to Medicare Advantage would force half of its current enrollees to switch back to the old, 1965-vintage Medicare program. Robert Book and James Capretta estimate that this will cost enrollees an average of $3,714 in 2017 alone.

New rates to be ‘enormously disruptive’

The new rates proposed by the Centers for Medicare and Medicaid Services, a.k.a. CMS, will have the net effect of reducing payments to Medicare Advantage plans by 7 to 8 percent in 2014, according to Citi managed care analyst Carl McDonald. “This includes the 2.3% reduction in per capita growth rate announced by CMS on Friday, and estimated 2-3% drop as rates move to parity with fee for service…a 1.5% reduction associated with the change in coding intensity adjustment” and the 2% health insurance premium tax. “These negatives are partially offset by an estimated 1% benefit from improved Star quality ratings, re-basing, better risk scores, and fee for service normalization, resulting in an overall decline of 7-8%,” wrote McDonald yesterday in a note to clients.

Because the typical for-profit managed care plan targets profit margins of only 5 percent, and non-profits even less, the net consequence would “turn almost every plan in the industry unprofitable,” according to McDonald, unless CMS changes its proposal. “If implemented, these rates and the program changes CMS is suggesting would be enormously disruptive to Medicare Advantage, likely forcing a number of smaller plans out of the business and creating disarray for many seniors.”

Could CMS bend the rules again?

CMS didn’t issue these rates because they’re mean. Obamacare requires these rate cuts; indeed, as I noted above, they were supposed to have been implemented before the election. “We appreciate that plans are facing several legislatively mandated changes affecting payment for 2014,” CMS’ Jonathan Blum and Paul Spitalnic write in their 199-page report. “We solicit comment on suggestions to address these challenges within the parameters of current law.” The final rates are to be issued on April 1.

CMS is likely to come under pressure to once again postpone the cuts, by engaging in rule-bending or accounting gimmicks. If CMS assumes that Congress passes a “doc fix” by the end of the year, in order to avoid a 25 percent reduction in physician reimbursement rates, plans could benefit from a 4 percent increase in government reimbursements. Understandably, CMS normally doesn’t incorporate the “doc fix” into its calculations unless one has been actually passed by Congress. CMS could also decline to implement a recalibration of its risk adjustment formula, something that would ease the pressure on insurers.

2014 will be the year when reality hits

It’s important to reduce the amount that the government spends on Medicare, and to do so in a way that minimally affects the care that seniors receive. The simplest way to do this is to gradually raise Medicare’s eligibility age by three months each year. Now that we have Obamacare’s insurance exchanges to support lower- to middle-income seniors, it’s not necessary to force Americans to pay taxes in order to subsidize health insurance for wealthy seniors like Warren Buffett and Mitt Romney.

But Obamacare chose a different path, one that will force more Americans into creaky, out-of-date programs like Medicaid and Sixties-era fee-for-service Medicare. The law will dramatically increase the cost of privately-purchased health insurance, something that Obamacare supporters are only now starting to admit.

There will be much more to talk about as the Obama administration issues the rates, regulations, and mandates that the “Affordable Care Act” requires. Stay tuned.

Follow Avik on Facebook and on Twitter at @aviksaroy.

INVESTORS’ NOTE: Among publicly-traded insurers, Universal American (UAM), Humana (HUM), WellCare (WCG), Cigna (CI), and UnitedHealth (UNH) garner the largest proportion of their revenue from Medicare Advantage.

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The Top Ten Health-Care Bills for 2013

February 20, 2013 4:00 A.M.

"Hands Off My Health Care" rally at Capitol Hill, March 27, 2012.

Last year, the two best opportunities to stop Obamacare before it got implemented were missed. First, Chief Justice John Roberts bent over backwards to find the law’s individual mandate to be a constitutional tax on the uninsured. Then, the voters decided they preferred another term for President Obama over a Romney administration.

As a consequence, Obamacare isn’t going to be wiped off the federal books in the next few years.

This reality has important implications for congressional tactics. In the previous two years, everything that was done in the Republican-controlled House of Representatives was aimed at building momentum for full repeal in the event Romney won the White House. Since that didn’t happen, other tactics are necessary.

Congressional opponents of Obamacare need to do two things in the months ahead. First, they need to pursue legislation that can contain and minimize Obamacare so that a future president and Congress can still change direction if they choose to do so. Second, Congress needs to continue to cultivate public opposition to Obamacare by highlighting strong bipartisan opposition to its worst features. Bipartisan bills to repeal or substantially amend the law are especially important because they will sow disunity among Democrats and create openings for future revision.

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The following is a top-ten list of health-care bills that could help Congress pursue these goals (although there are, of course, many other good ideas that would also help the cause). Each of these items could be pursued as stand-alone bills on the House floor.

1. Delay
The Obama administration chose to delay many of the most controversial implementing rules of Obamacare during 2012 to avoid stirring up opposition to the president during the election year. That decision has now put everything behind schedule. Moreover, a majority of states have decided (as was their right) not to build the state exchanges envisioned in the law, leaving the task to the federal government. And there’s no direct appropriation available to the federal government for this task. So it’s quite clear that implementing the law by January 2014 will create significant and unnecessary chaos in the insurance marketplace. Republicans should seize the opportunity this state of affairs provides and push for a delay of the law’s implementation. The administration will of course vigorously oppose any suggestion of delay, but many employers, states, and health-sector participants would welcome it.

2. IPAB Repeal
The Independent Payment Advisory Board (IPAB) is the poster child of the Obama vision for cost control. The new agency, composed of 15 unelected “experts,” is supposed to enforce a new cap on Medicare spending growth, without any political accountability to the program’s beneficiaries. Moreover, the only tools IPAB can use are further reductions in what Medicare pays for the provision of services to patients. But these kinds of price controls drive suppliers out of the program and leave beneficiaries on waiting lists for services. A clean IPAB-repeal bill — with no other poison pills attached to it — is sure to draw significant Democratic support. The GOP should ensure such a vote occurs soon.

3. Scale Back Premium-Credit Subsidies
Obamacare has set in motion the largest entitlement expansion in a generation. In theory, the new law entitles all Americans with incomes between 133 percent and 400 percent of the poverty line to new subsidies for health insurance. According to the Census Bureau, there are 110 million Americans under age 65 in that income range. Once the subsidies are in place, the pressure in Congress will be to expand benefits for this large new cohort of entitled voters. President Obama has often said that Massachusetts was the model for the national law. Well, Massachusetts cut off its new entitlement at 300 percent of the poverty line. The House should advance a bill to do the same with Obamacare before the entitlement goes into effect.

4. Repeal the Uninsured Tax (the Individual Mandate)
The chief justice ruled that the individual mandate could survive as a constitutional tax on those who fail to buy government-approved insurance. But that didn’t make it any more popular. Indeed, now that it is clearly just a tax on the uninsured, it will be more unpopular than ever. Ironically, according to the Congressional Budget Office, a repeal of this tax would reduce the deficit by nearly $300 billion over a decade as it would lead to fewer participants in the Obamacare entitlement expansion.

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Some Employers Could Opt Out of Insurance Market, Raising Others’ Costs

Companies can avoid many standards in the new law by insuring their own employees, rather than signing up with commercial insurers, because Congress did not want to disrupt self-insurance arrangements that were seen as working well for many large employers.

“The new health care law created powerful incentives for smaller employers to self-insure,” said Deborah J. Chollet, a senior fellow at Mathematica Policy Research who has been studying the insurance industry for more than 25 years. “This trend could destabilize small-group insurance markets and erode protections provided by the Affordable Care Act.”

It is not clear how many companies have already self-insured in response to the law or are planning to do so. Federal and state officials do not keep comprehensive statistics on the practice.

Self-insurance was already growing before Mr. Obama signed the law in 2010, making it difficult to know whether the law is responsible for any recent changes. A study by the nonpartisan Employee Benefit Research Institute found that about 59 percent of private sector workers with health coverage were in self-insured plans in 2011, up from 41 percent in 1998.

But experts say the law makes self-insurance more attractive for smaller employers. When companies are self-insured, they assume most of the financial risk of providing health benefits to employees. Instead of paying premiums to insurers, they pay claims filed by employees and health care providers. To avoid huge losses, they often sign up for a special kind of “stop loss” insurance that protects them against very large or unexpected claims, say $50,000 or $100,000 a person.

Such insurance serves as a financial backstop for the employer if, for example, an employee is found to have cancer, needs an organ transplant or has a premature baby requiring intensive care.

In a report to clients last year, SNR Denton, a law firm, wrote, “Faced with mandates to offer richer benefits with less cost-sharing, small and midsize employers in particular are increasingly considering self-insuring.”

Officials from California, Maine, Minnesota, Utah, Washington and other states expressed concern about the potential proliferation of these arrangements at a recent meeting of the National Association of Insurance Commissioners.

Stop-loss insurers can and do limit the coverage they provide to employers for selected employees with medical problems. As a result, companies with less healthy work forces may find self-insuring more difficult.

Christina L. Goe, the top lawyer for the Montana insurance commissioner, said that stop-loss insurance companies were generally “free to reject less healthy employer groups because they are not subject to the same restrictions as health insurers.”

Insurance regulators worry that commercial insurers — and the insurance exchanges being set up in every state to offer a range of plan options to consumers — will be left with disproportionate numbers of older, sicker people who are more expensive to insure.

That, in turn, could drive up premiums for uninsured people seeking coverage in the exchanges. Since the federal government will subsidize that coverage, it, too, could face higher costs, as would some employees and employers in the traditional insurance market.

Large employers with hundreds or thousands of employees have historically been much more likely to insure themselves because they have cash to pay most claims directly.

Now, employee benefit consultants are promoting self-insurance for employers with as few as 10 or 20 employees.

Raeghn L. Torrie, the chief financial officer of Autonomous Solutions, a developer of robotic equipment based in Petersboro, Utah, said her business started a self-insured health plan for its 44 employees on Jan. 1 as a way to cope with the uncertainties created by the new law.

“We have a pretty young, healthy group of employees,” she said.

In Marshfield, Mo., J. Richard Jones, the president of Label Solutions, an industrial label-printing company with 42 employees, said he switched to a self-insurance plan this year “to hold down costs that were going up because of government regulation under Obamacare.”

The Township of Freehold, N.J., made a similar decision in January to gain more control over benefits and costs for its 260 employees.

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Maryland Senate Committee Votes To Repeal Death Penalty

A bill to repeal the death penalty in Maryland cleared the state Senate Judicial Proceedings Committee last night. The bill, a major priority for Gov. Martin O’Malley (D-MD), is expected to pass the state senate, where 26 of the body’s 47 members have said they will support the bill.

If the bill also passes the state house, where it is expected to have an easier road than it did in the senate, Maryland will join a growing national trend away from executions. According to a 2011 study by the Death Penalty Information Center, thirty-two U.S. jurisdictions executed no one in the proceeding five years. Moreover, although the death penalty is still technically legal in most states, executions themselves are rare outside handful of mostly Southern states. More than one third of all executions occurred in Texas:

The increasing rarity of the death penalty has constitutional implications. The Eighth Amendment to the Constitution forbids “cruel and unusual punishments.” Thus, as the death penalty becomes more and more unusual — or, as the Supreme Court has put it, as it no longer comports with “evolving standards of decency that mark the progress of a maturing society” — it stands on weaker and weaker constitutional footing.

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Three Problems Contributing To Americans’ Sky High Medical Bills — And Three Ways To Fix Them

This week’s issue of Time Magazine takes a deep dive into Americans’ medical bills and the roots of the U.S. health care industry’s rampant inflation — costs that force one in four American seniors into bankruptcy and over one in three Americans to forgo care.

The investigative piece highlights the exorbitant costs of the most commonplace procedures and medications, and how insurance coverage often falls through for Americans who encounter unaffordable out-of-pocket costs due to the rising price of health care technology and services. Furthermore, it is often impossible for patients to ascertain why they are being charged what they are for care — a pricing opacity that is truly unique to the service-centered health care industry. Here are the three biggest takeaways from the Time exposé on the unsustainable foundations of American health care costs — and some ideas for shifting the U.S. medical landscape towards a more equitable system:

The indefensible costs of medical testing, technology, and drugs. Much of the report focuses on the costs of receiving basic care and testing, such as diabetes tests, drawing blood samples, or even taking plain old Tylenol — which one hospital in the report marked up to $1.50 per pill, approximately 100 times its general market price, for a cancer patient. Hospitals are largely able to get away with this because they are, as the article puts it, “sellers in what is the ultimate seller’s market,” so device manufacturers, pharmaceutical companies, and hospital chains — even technically “nonprofit” ones — are free to run up the tabs on Americans’ care. Use market competition and price negotiations to lower costs. In its Senior Protection Plan, the Center for American Progress (CAP) advocates tying relatively low Medicare drug rebates to more generous Medicaid drug rebates, and enforcing competitive bidding for all health care products in both the public and private sectors, as well as intrastate price negotiations in the private medical sector that constrains annual spending to a predesignated cap. All told, such reforms would reduce American health care spending by at least $180 billion.People usually don’t know why they get charged what they do for care. It’s a common mantra among health care reform advocates — America doesn’t have a health care system, it has a sick care system. Services are charged after the fact, often in the form a hefty, inscrutable bill that tells patients very little about why they are being asked to pay tens of thousands of dollars in order to receive care that can mean the difference between life and death. This opacity allows providers to get away with jacking up the price of services even as medical technology makes huge strides — which should theoretically lower costs. One GAO report states that “the lack of price transparency and the substantial variation in amounts hospitals pay for some IMD [implantable medical devices] raise questions about whether hospitals are achieving the best prices possible.”Make hospitals issue easily understandable receipts for all health care services.This is a relatively simple fix that would help facilitate further cost reductions by rooting price negotiations in easily-available, verifiable, and uniform data. As the CAP health policy team’s Topher Spiro states in an email to ThinkProgress, “We propose full price transparency—so it wouldn’t take a seven month investigation by a reporter to find out what prices are being charged.” The best possible outcome would be for hospitals and insurers to provide a comprehensive list of services to all patients and beneficiaries that let Americans know exactly how much a particular disease treatment or procedure will cost them.Americans get care at expensive hospital chains that don’t necessarily provide the best service. As Time’s article points out, national and multi-national hospital chains rule the American medical industry — but that doesn’t mean they provide the cheapest, highest quality, or most efficient care. For instance, at the Texas giant MD Anderson, hospital administrators charged Sean Recchi over ten times as much for a chest x-ray as they would have been reimbursed by Medicare, which is required by law to approximate the price of services rendered. Why? Because Sean Recchi had subpar private insurance, and MD Anderson could get away with it.Encourage patients to visit high-performing hospitals with insurance incentives. Americans might believe that such hospitals are their only recourse — but that doesn’t have to be true. One approach to encouraging providers to provide more efficient, quality, and affordable care would be the creation of tiered insurance plans that reward patients — through lower premiums and deductibles — who use low-cost, high-quality hospitals for their care instead of the highest-cost brand name hospitals.

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The Flu Hit American Workers Hard in January

The BLS noted that more people typically call in sick during the winter months, when seasonal illnesses such as cold and the flu are common. But this year appears to have been especially hard on Americans, and on workers.

The flu season got off to an early and aggressive start, but the good news is that it appears to have peaked in late January, according to the Centers for Disease Control.

Still, experts warn that the flu could continue to circulate for months.

In addition, other bugs, such as common colds and the stomach flu, can keep workers from heading into the office.

For many workers, getting sick can literally be costly. There is no federal requirement that companies provide paid sick leave, although companies who are subject to the Family and Medical Leave Act requires unpaid sick leave.

About 66 percent of workers have access to paid sick leave, according to the Bureau of Labor Statistics. Full-time workers are much more likely than part-time workers to have paid sick leave, according to the BLS.

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5 Ways The Sequester Could Make You Sick

In just a week, the United States will hit the deadline for the sequester — the automatic spending cuts that were negotiated during the 2011 debt ceiling deal. The spending cuts will begin going into effect on March 1 unless lawmakers broker a compromise to avert sequestration, as they did at the beginning of this year when they agreed to push the deadline back two months. But so far, there’s no sign of a deal.

The sequester’s across-the-board indiscriminate cuts were designed to force lawmakers to reach a deal to reduce the deficit. If they end up going into effect, they could have disastrous consequences on Americans’ health. Here are the top five ways that sequestration will make the nation a less healthy place:

1. More Americans could be put at risk for foodborne illnesses. The number of Americans who get sick or die after consuming contaminated food has increased 44 percent over the last two years. The FDA is currently stretched too thin after rounds of budget cuts to food safety programs, and the sequester will only worsen the situation even more. Cuts to the FDA would lead to 2,100 fewer food inspections across the country, putting more Americans at risk for contracting foodborne illnesses — which already cost the United States about $152 million each year to treat.

2. Medical researchers will be forced to delay the development of treatments that could help sick Americans. An 8.2 percent across-the-board cut to the National Institutes of Health (NIH) could set back medical science for a generation, according to a former NIH director. Existing research would have to be scaled back, and new research projects would have to be postponed — potentially eliminating thousands of research positions across the country, and preventing scientists from doing critical work to develop new treatments for chronic conditions and rare diseases.

3. The government will have fewer resources to provide Americans with health coverage. Under Obamacare, an estimated 9 million previously uninsured Americans will gain health coverage in health insurance marketplaces that states are getting ready for 2014 — but sequestration could slow the implementation of that provision by cutting $66 million in grants intended to help states set up those marketplaces. Similarly, the agency that oversees the public Medicare and Medicaid programs will lose more than $60 million for its program management if the sequester cuts go into effect. And reductions in grants that help fund community health centers, which often serve the most vulnerable Americans, could result in 900,000 fewer adults receiving medical care.

4. Thousands of Americans living with mental illnesses could go untreated. The sequester would result in a $275 million cut to the Substance Abuse and Mental Health Services Administration and the Mental Health Block Grant program, which help Americans access the mental health care they need. That means that up to 373,000 “seriously mentally ill adults and seriously emotionally disturbed children” may be forced to go without the treatment they rely on, which could lead to an uptick in hospitalizations. And an estimated 8,900 homeless people with mental illnesses may not be able to receive the kind of support — including outreach, treatment, and housing assistance — that is critical to helping their recovery process.

5. Fewer Americans will get screened and treated for HIV. According to the Department for Health and Human Services, the sequestration cuts will have a serious impact on federal official’s ability to continue combating the nation’s HIV/AIDS epidemic. Since an estimated 20 percent of HIV-positive Americans still don’t know they have the virus, the CDC warns that testing needs to be a top priority — but the cuts to the CDC’s programs would result in about 424,000 fewer HIV tests conducted by state agencies. And an estimated 7,400 fewer patients would have access to their HIV medications through the AIDS Drug Assistance Program.

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